Lifestyle Factors that Improve Metabolic Syndrome Components


Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Cholesterol in Adults (Adult Treatment Panel III)

National Cholesterol Education Program, National Heart, Lung, and Blood Institute; National Insitutes of Health, NIH Publication No. 02-5215, September 2002

Study Design:
Meta-analysis or Systematic Review
M - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:
To update ATP I and II by developing evidence-based recommendations for clinical management of high blood cholesterol and related abnormalities.
Inclusion Criteria:
Exclusion Criteria:
Description of Study Protocol:

ATP III panel had four roles to:

1) Systematically review the literature and judged which reports provided relevant information

2) Synthesize literature into a series of evidence statements and judge the strength of the evidence

3) Develop recommendations based on evidence statements

4) Create an integrated set of recommendations and guidelines

Data Collection Summary:


Description of Actual Data Sample:

Summary of Results:

General approach to therapeutic lifestyle changes (TLC)*:

1) Reduce intakes of saturated fats (<7% of total calories) and cholesterol (<200 mg/day)

2) Therapeutic options for enhancing LDL lowering (plant sterols/stanols (2 g/day) and increased viscous (soluble) fiber (10-25 g/day)

3) Weight reduction (adjust caloric intake to maintain desirable body weight/prevent weight gain)

4) Increased regular physical activity (include enough moderate exercise to expend at least 200 Kcal per day)

After maximum LDL lowering is achieved with dietary therapy, emphasis shifts to management of the metabolic syndrome and it associated lipid risk factors (elevated TG and low HDL-C)

1) weight reduction

2) physical activity


* Macronutrient recommendations for the TLC diet

Polyunsaturated fat, up to 10% of total calories

Monounsaturated fat, up to 20% of total calories

Total fat, 25-35% of total calories

Carbohydrate, 50-60% of total calories

Dietary fiber, 20-30 g/day

Protein, approximately 15% of total calories

ATP III allows an increase of total fat to 35% and a reduction in carbohydrates to 50% for persons with the metabolic syndrome. An increase in fat should be in the form of polyunsaturated fatty acids or monounsaturated fatty acids. Carbohydrates should be from foods rich in complex carbohydrates including grains-especially whole grains-fruits and vegetables.

Author Conclusion:
Funding Source:
Government: NHLBI, NIH
Reviewer Comments:
The complete ATP III report includes useful assesment tools and sample menus.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes